Indiana State Department of Health

Indiana Children’s Special Health Care Services (CSHCS) provides supplemental medical coverage to help families of children who have serious, chronic medical conditions, age birth to 21 years of age, who meet the program’s financial and medical criteria, pay for treatment related to their child’s condition.

Children's Special Health Care Services Brochure in English and Spanish.

Financial Eligibility

A family with an income, before taxes, no greater than 250% of the federal poverty level may be eligible for the program. The financial level changes every year. For example, in 2014, a family of four could qualify with a gross income of up to $59,625.

Medical Eligibility

Children’s Special Health Care Services (CSHCS) is a program to help Indiana children with severe chronic medical conditions which:

Have lasted (or are expected to last) at least two years;

Will produce disability, disfigurement, or limits the child’s ability to function;

Requires special diet or devices; or

Without treatment would produce a chronic disabling physical condition.

Some of the physical conditions which may qualify a child for services from CSHCS include:

Apnea

Arthritis

Asthma-Severe, 2 medications daily

Autism

Cerebral Palsy

Chronic Anemia (e.g. Sickle Cell)

Chromosomal Disorders

Chronic Pulmonary Disease

Cleft Lip and/or Palate

Congenital or Acquired Developmental Deformities

Congenital Heart Disease or Arrhythmias

Cystic Fibrosis (life time medical eligibility)

Endocrine Deficiencies (e.g. Diabetics)

Hydrocephalus

Inflammatory Bowel Disease

Inborn Errors of Metabolism (e.g. PKU)

Myelodysplasia or Spinal cord Dysfunction (e.g. Spina Bifida)

Neuromuscular Dysfunction

Oncologic Disorders (e.g. Cancer)

Profound Bilateral Hearing Loss

Renal Disease

Seizure Disorder

Severe Hemophilia

What services are available?

For eligible applicants, services may include:

Diagnostic evaluations

Comprehensive well child and sick child care

Specialty care and other services related to the eligible medical conditions

Proof for all household members income (three consecutive current paycheck stubs or recent federal income tax forms)

Important items to remember:

When requesting prior authorization, please make sure that the National Provider Identifier (NPI) number you give to the PA nurse is the same NPI number you will use when you submit a claim for payment. The NPI number that appears on the prior authorization must match the NPI number that is in the pay-to box (field) on the claim. If these numbers do not match, your claim may be denied.

All primary insurance policies must be followed before CSHCS will consider payment.

All insurance must be used first

All equipment, supplies, therapy, hospitalizations, and emergency room visits must be directly related to the eligible medical condition and must be authorized.

Medical and financial eligibility will be reevaluated annually.

Contact the CSHCS Eligibility Section at 1-317-233-1351 or 1-800-475-1355, Option 2, with any questions regarding enrollment. Questions about care coordination, referrals or other information may be directed to the Care Coordination Section at 1-317-233-1351 or 1-800-475-1355, Option 7, or via email at cshcscarecoordinatio@isdh.in.gov.